Effect of Comprehensive Behavioral and Exercise Intervention on Physical Function and Activity Participation After Total Knee Replacement: A Pilot Randomized Study.

OBJECTIVE: To test the feasibility of a comprehensive behavioral intervention (CBI) program that combines intense exercises with an education program, to be implemented at a later stage (3 months) following total knee replacement (TKR), and to get a first impression of the effects of the CBI as compared to a standard of care exercise (SCE) program on the outcomes of physical function and physical activity. METHODS: A total of 44 subjects participated in a 3-month program of either CBI or SCE, followed by 3 months of a home exercise program. Outcomes of physical function and physical activity were measured at baseline and at 6-month followup. Analysis of variance was used to compare statistical differences between groups, whereas responder analyses were used for clinically important differences. RESULTS: The CBI was found to be safe and well tolerated. As compared to the SCE group, the CBI group had less pain (P = 0.035) and better physical function based on the Short Form 36 health survey (P = 0.017) and the single-leg stance test (P = 0.037). The other outcome measures did not demonstrate statistically significant differences between the 2 groups. Results from the responder analysis demonstrated that the CBI group had a 36% higher rate of responders in physical function as compared to the SCE group. Also, the CBI group had 23% more responders in the combined domains of physical function and physical activity. CONCLUSION: The CBI program is feasible and improves physical function and physical activity in patients several months after TKR. Larger pragmatic randomized trials are needed to confirm the results of this study.

Effect of Wearable Technology Combined With a Lifestyle Intervention on Long-term Weight Loss: The IDEA Randomized Clinical Trial.

Importance: Effective long-term treatments are needed to address the obesity epidemic. Numerous wearable technologies specific to physical activity and diet are available, but it is unclear if these are effective at improving weight loss. Objective: To test the hypothesis that, compared with a standard behavioral weight loss intervention (standard intervention), a technology-enhanced weight loss intervention (enhanced intervention) would result in greater weight loss. Design, Setting, Participants: Randomized clinical trial conducted at the University of Pittsburgh and enrolling 471 adult participants between October 2010 and October 2012, with data collection completed by December 2014. Interventions: Participants were placed on a low-calorie diet, prescribed increases in physical activity, and had group counseling sessions. At 6 months, the interventions added telephone counseling sessions, text message prompts, and access to study materials on a website. At 6 months, participants randomized to the standard intervention group initiated self-monitoring of diet and physical activity using a website, and those randomized to the enhanced intervention group were provided with a wearable device and accompanying web interface to monitor diet and physical activity. Main Outcomes and Measures: The primary outcome of weight was measured over 24 months at 6-month intervals, and the primary hypothesis tested the change in weight between 2 groups at 24 months. Secondary outcomes included body composition, fitness, physical activity, and dietary intake. Results: Among the 471 participants randomized (body mass index [BMI], 25 to <40; age range, 18-35 years; 28.9% nonwhite, 77.2% women), 470 (233 in the standard intervention group, 237 in the enhanced intervention group) initiated the interventions as randomized, and 74.5% completed the study. For the enhanced intervention group, mean base line weight was 96.3 kg (95% CI, 94.2-98.5) and 24-month weight 92.8 kg (95% CI, 90.6- 95.0) [corrected]. For the standard intervention group, mean baseline weight was 95.2kg (95%CI,93.0-97.3)and24-month weight was 89.3 kg (95%CI, 87.1-91.5) [corrected]. Weight change at 24 months differed significantly by intervention group (estimated mean weight loss, 3.5 kg [95% CI, 2.6-4.5} in the enhanced intervention group and 5.9 kg [95% CI, 5.0-6.8] in the standard intervention group; difference, 2.4 kg [95% CI, 1.0-3.7]; P = .002). Both groups had significant improvements in body composition, fitness, physical activity, and diet, with no significant difference between groups. Conclusions and Relevance: Among young adults with a BMI between 25 and less than 40, the addition of a wearable technology device to a standard behavioral intervention resulted in less weight loss over 24 months. Devices that monitor and provide feedback on physical activity may not offer an advantage over standard behavioral weight loss approaches. Trial Registration: clinicaltrials.gov Identifier: NCT01131871.

Short-term weight loss with diet and physical activity in young adults: The IDEA study.

OBJECTIVE: This study examined the effect of a behavioral weight loss intervention (BWLI) on young adults (age = 18-35 years). METHODS: Participants (N = 470) enrolled in a 6-month BWLI that included weekly group sessions, a prescribed energy-restricted diet, and moderate to vigorous physical activity (MVPA). Assessments included weight, body composition, fitness, lipids, glucose, insulin, resting blood pressure and heart rate, physical activity, and dietary intake. Data are presented as median [25th, 75th percentiles]. RESULTS: Retention was 90% (N = 424; age: 30.9 [27.8, 33.7] years; BMI: 31.2 [28.4, 34.3] kg m(-2) ). Participants completed 87.5% [76.1%, 95.5%] of scheduled intervention contacts. Weight and body fat decreased while fitness increased (P < 0.0001). MVPA in bouts ≥10 min increased (P < 0.0001), though total MVPA did not change significantly. Sedentary time decreased (P = 0.03). Energy and percent fat intake decreased, while percent carbohydrate and protein intake increased (P < 0.0001). Systolic and diastolic blood pressure, total cholesterol, LDL cholesterol, triglycerides, glucose, and insulin decreased (P < 0.0001). CONCLUSIONS: A 6-month BWLI produced favorable changes in dietary intake and physical activity and elicited favorable changes in weight and other health outcomes in young adults. MVPA performed in bouts of ≥10 min was associated with greater weight loss, but sedentary behavior was not.

The comparison of a technology-based system and an in-person behavioral weight loss intervention.

The purpose of this study was to compare a technology-based system, an in-person behavioral weight loss intervention, and a combination of both over a 6-month period in overweight adults. Fifty-one subjects (age: 44.2 ± 8.7 years, BMI: 33.7 ± 3.6 kg/m(2)) participated in a 6-month behavioral weight loss program and were randomized to one of three groups: standard behavioral weight loss (SBWL), SBWL plus technology-based system (SBWL+TECH), or technology-based system only (TECH). All groups reduced caloric intake and progressively increased moderate intensity physical activity. SBWL and SBWL+TECH attended weekly meetings. SBWL+TECH also received a TECH that included an energy monitoring armband and website to monitor energy intake and expenditure. TECH used the technology system and received monthly telephone calls. Body weight and physical activity were assessed at 0 and 6 months. Retention at 6 months was significantly different (P = 0.005) between groups (SBWL: 53%, SBWL+TECH: 100%, and TECH: 77%). Intent-to-treat (ITT) analysis revealed significant weight losses at 6 months in SBWL+TECH (-8.8 ± 5.0 kg, -8.7 ± 4.7%), SBWL (-3.7 ± 5.7 kg, -4.1 ± 6.3%), and TECH (-5.8 ± 6.6 kg, -6.3 ± 7.1%) (P < 0.001). Self-report physical activity increased significantly in SBWL (473.9 ± 800.7 kcal/week), SBWL+TECH (713.9 ± 1,278.8 kcal/week), and TECH (1,066.2 ± 1,371 kcal/week) (P < 0.001), with no differences between groups (P = 0.25). The TECH used in conjunction with monthly telephone calls, produced similar, if not greater weight losses and changes in physical activity than the standard in-person behavioral program at 6 months. The use of this technology may provide an effective short-term clinical alternative to standard in-person behavioral weight loss interventions, with the longer term effects warranting investigation.

Acute effect of walking on energy intake in overweight/obese women.

This study examined the acute effect of a bout of walking on hunger, energy intake, and appetite-regulating hormones [acylated ghrelin and glucagon-like peptide-1 (GLP-1)] in 19 overweight/obese women (BMI: 32.5 ± 4.3 kg/m²). Subjects underwent two experimental testing sessions in a counterbalanced order: exercise and rest. Subjects walked at a moderate-intensity for approximately 40 min or rested for a similar duration. Subjective feelings of hunger were assessed and blood was drawn at 5-time points (pre-, post-, 30-, 60-, 120-min post-testing). Ad libitum energy intake consumed 1-2h post-exercise/rest was assessed and similar between conditions (mean ± standard deviation; exercise: 551.5 ± 245.1 kcal [2.31 ± 1.0 MJ] vs. rest: 548.7 ± 286.9 kcal [2.29 ± 1.2 MJ]). However, when considering the energy cost of exercise, relative energy intake was significantly lower following exercise (197.8 ± 256.5 kcal [0.83 ± 1.1 MJ]) compared to rest (504.3 ± 290.1 kcal [2.11 ± 1.2 MJ]). GLP-1 was lower in the exercise vs. resting condition while acylated ghrelin and hunger were unaltered by exercise. None of these variables were associated with energy intake. In conclusion, hunger and energy intake were unaltered by a bout of walking suggesting that overweight/obese individuals do not acutely compensate for the energy cost of the exercise bout through increased caloric consumption. This allows for an energy deficit to persist post-exercise, having potentially favorable implications for weight control.

Comparison of techniques for self-monitoring eating and exercise behaviors on weight loss in a correspondence-based intervention.

This study examined whether different methods of self-monitoring eating and exercise behaviors affect the process of self-monitoring and change in body weight in overweight adults. Forty-two subjects participated in a 16-week correspondence-based weight-loss intervention using a pretest-posttest randomized design. Dietary intake was prescribed at 1,200 to 1,500 kcal/day and <30% dietary fat. Physical activity was progressed to 200 minutes/week. Participants were randomly assigned to self-monitoring eating and physical activity behaviors using a traditional detailed method or transitioning to an abbreviated method. Transitioning to an abbreviated method returned significantly more diaries than using a traditional detailed method (P=0.04). Participants completing the study showed no significant difference in weight loss between the traditional detailed method (-7.5+/-5.3 kg) and the abbreviated method (-7.6+/-5.5 kg), with similar results for intention-to-treat analysis (detailed method -3.9+/-5.3 kg vs abbreviated method -4.3+/-5.8 kg). Weight loss was significantly associated with number of self-monitoring diaries completed (r=0.53, P<0.05). Findings suggest the self-monitoring process, rather than the detail of self-monitoring, is important for facilitating weight loss and change in eating and physical activity behaviors. Transitioning to a simplified approach to self-monitoring does not negatively affect short-term weight loss in overweight adults. These results may have implications for improving self-monitoring in overweight adults during periods of weight loss.